| NPI | 1417203217 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA2148) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TN 2148) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2019-08-16 |